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FOR OFFICE USE: <br /> / ��PPLKCATl���� FOR SANITATION PERMIT Permit No. ~ <br /> � <br /> o <br /> �m <br /> k� �f��n <br /> � `��.- Duplicate) Duhy Issued <br /> . This Permit Expires 1 Year From 'Date Issued. <br /> Application is n,6v made to the Sun Joaquin Local Health District for a permit to construct and instan the work herein described. <br /> This application is made in compliance -;4th County Ordinance No. 549. <br />� ADDRESS AND ^�LOCATION--- ------ <br /> Owner's <br /> . <br /> A66nss <br /> ------' <br /> -- <br /> Contractor's N ---------------------------- <br /> Installation <br /> '-'--'-- <br /> |mstallation will serve: Residence.. -1 <br /> ~ . ��Hm� House <br /> Commercial E] 4 | Court <br /> 0 <br /> Nwm6o, of K°�g units: .y-' Number of bedrooms 5' Number of baths '''' Lot size <br /> ' � � -- <br /> ''-'-' <br /> �� Supply: Public system � Community system [-] Private to ��.� <br /> Character of soil to a depth of 3 feet' Sand [] Gravel E] Sandy Loam E] Clay Loam [] C| Adobe pan El <br />` Pm"invw Application Made: Ufv°s'6ote- -'---- > No E] Now Construction: Ye, 0 No X FHA/VA. Y=, [] No - <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu6|ic sewer ba"uilu6le within 200 feet.) <br />� Distance from nearest we|L-----Di,tunca from foundation--------------------Material -------- ----- ----------- <br /> DisC%��Il Distance from nearest Distance from <br /> lin <br /> � ' -� --'---'-' <br /> i '`""�=` "` lines" .-Length of each line------- Width of french---- <br /> Distance to neo n��«�«�..c u�� - -m � <br /> .��^��- ,�nnce �o nous | <br /> ^ <br /> Number of p/�-./------.`Uning -' S� � <br /> �� Dme+ c'�� ����r -Daofh -.�� �-�.---' <br /> -�� <br /> �~ ^� . <br /> [�eopoo|: D�+ n;o'�om neum,+`~eU -----.Didnnce �om'�ouncl^+ipn-----.. 'Lining ----------- <br />/ [] Size: Diameter. ' -- -Dvot -----------------------------------------------------Liquid Capacity.--------------------- ----gals. <br /> Privy: Distance from n�°n:sfwe||-............---------- ------------ .........Distance from nearest building--- __''''-'_____-- <br /> F1 Distance to nearest lot1ino`� -------------_������___________,_______________ ~ <br /> � <br /> Remodeling and/or repairing (6ns r;6e):-------- ---------------- --------- ------------------------------------------------------------------------------------------------------------------ <br /> ° <br /> ---------------------------------------------------------- -------------------- -_-----------__-------------------_-._------- <br /> ----------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------- ------- -''-''-''-- <br /> � <br /> ----'�-��~,-----'_-''-'''-'_-'''---_''-''''-'-'�----'''-----''--.--''---'-''---_''-- ---- <br /> 6�, ^ n6 that the work will 6e done in accordance with San Joaquin County <br /> ordinances. State laws, and rules and legulations of the San Joaquin Loral Health Di ic+. <br />| ~ <br />' Signed) ' -�~ � <br />. (Plm planshowing size of lot, locaflof system mation to wells, buildi 5, etc., can 6e placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br />� "''L'C~''"'` A~C"' '`° "'--------- ---,°`��-^��+''��~°=°°=�==-------------------------- u^/c-----5-- <br /> REVIEWED8Y---� -------- ----------_ ....... - ------------------'''-' ---------------- -------------------------- DATE''''''7- <br /> BUILDING PERMIT ISSUED-------- -'''_''-''-''-'--'----'--------------------------------- ----- DATE---- ------------ -_,__-_�_________ <br />. AKo,aGon» and/or r000mmmnn6a+iono�---._-- ----------.--_-_____________.______________.__ <br /> , . <br /> -.--__-'--- _ <br /> - ,'''--._-----._-..-'---''------�''----''-------''-''''''-'---'----. <br /> '__'-''_-.-''---_''''-'---'''_---'�-���'-�------'--''''--'''---''--'----'_'--''--'-' <br /> ....................... .... ---------- _ ------- _------ _------------------------------------------------------ ---- --------------- --------------------------------- ........ _ ---------- �----- <br /> ................--_-_-���---�����----................ --------------------------------------- -- ----------------------------------- -- ------ ------- -'- ---------- ---------- <br />' <br />| FIN/\L INSPECTION BY:......... -- '- Date............. <br /> -'��'�_�������/~�' <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br />| 1601 E.Haxeltan Ave. / 300 West Oak Street 1»*Sycamore Street 205 West 9th Street <br />� Stockton,California / tod/ California ' Manteca,California Tracy,California <br /> e.Kr2w''m Vanguard Press <br />